Waking up to urinate at night (Nocturia) is waking up one or more times during the night due to the need to urinate. Waking up due to pain, insomnia, noise and some mental problems and going to the toilet are not included in this scope. Again, it is not nocturia to go to the toilet first thing in the morning. Normally, urine production is reduced by half due to the hormone called ADH secreted at the base of the brain while sleeping at night, and there is no need to get up to urinate during 6-8 hours of sleep. The need to get up to go to the toilet is not normal and is a medical condition that should be examined especially if it is accompanied by other complaints. Besides, of course, the bladder is a social organ. If it does, it’s worth checking out. The more you need to get up at night to urinate, the more it will disrupt your sleep and affect your tiredness during the day, your ability to concentrate on your work, your daily activities and your social life. In addition, people who work night shifts and sleep during the day have the same need to urinate during the day. It is more common in women under the age of 30 and men over the age of 50. It is seen at a similar rate in both men and women over the age of 60.
Causes and types of the need to get up to urinate at night
There are many reasons for the need to get up at night to urinate, depending on the type.
Excess urine production (Polyuria): Polyuria patients produce more than 3 liters of urine in 24 hours. This is usually due to having too much water filtered by the kidneys. It occurs in some conditions that cause excessive urine production, such as Type 1,2 Diabetes or primary polydipsia (Diabetes insipidus-Pseudo-diabetes), and gestational diabetes, which cause excessive fluid intake, dry mouth and cause you to drink a lot of water.
Excessive urine production at night (Nocturnal polyuria): In nocturnal polyuria, high volume urine production occurs only at night. However, urine volumes during the day are normal or even decreased. This is usually due to fluid retention that accumulates in the feet or legs during the day due to edema. When you lie down to sleep, when the gravity-related negativity dissipates, the fluid in the edematous areas returns to your veins and is filtered by your kidneys, causing excessive urine production.
Causes of edema and excess fluid accumulation:
Chronic renal failure
Edema of the lower extremities (swelling of the legs).
Sleep disorders such as obstructive sleep apnea (breathing is interrupted or stopped many times during sleep).
Some medications, including diuretics-diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excess vitamin D.
Drinking lots of fluids before bedtime, especially coffee, caffeinated beverages, or alcohol.
Eating a high-salt meal.
Decreased production of the hormone ADH-Vasopressin
Nocturnal urination frequency (True Nocturia): It refers to the need to get up to urinate at night, although the production of urine at night is normal. In fact, the total amount of urine produced is not high. This is usually because the bladder does not empty completely (so it fills up faster) or because the bladder does not fill completely before you develop the urge to urinate (low bladder volume). This may also occur due to difficulty sleeping, but is not included in the scope of nocturia.
Reasons for not being able to empty your bladder completely:
bladder outlet obstruction
Congenital bladder outlet obstruction and urinary tract obstruction
Causes of the bladder’s inability to fully store urine may include:
Bladder overactivity (bladder spasms).
Bladder infection or recurrent urinary tract infection.
Bladder inflammation (swelling).
Interstitial cystitis-painful bladder syndrome.
The need to get up to urinate at night – Diagnosis of nocturia
The diagnosis of nocturia is somewhat simple, but understanding the underlying causes is quite complex. Therefore, nocturia can also be a symptom of some other potentially serious medical conditions. First, the doctor will learn your medical history and perform a physical examination. Your doctor may ask you to fill out an inquiry form to better understand your symptoms and their impact on your quality of life. The most commonly used questioning form is “Nocturia-Quality of Life” (N-QoL). Again, he may keep a bladder-void diary to aid diagnosis. This is a two- to three-day record of how much fluid you drink, how often you go to the toilet, and how much urine you urinate (volume in mL). is registered. You can easily do it at home with the help of a measuring cup. You may also mention a sudden urge to urinate and incontinence. You should also record any medications you take, urinary tract infections, and associated symptoms. Your doctor will review the diary to determine possible causes and treatment for the need to get up at night.
Your doctor may ask you the following questions:
When did this situation start?
How many times do you urinate each night?
How much volume do you pee when you urinate at night?
Has there been a change (increase or decrease) in the rate and thickness of urination?
How much caffeine-coffee do you drink daily?
Is urination during the night keeping you from getting enough sleep?
Do you drink alcoholic beverages? How often and how much?
Has your diet changed recently?
In addition to reviewing your voiding diary, your doctor may order a urinalysis to examine your urine for infection.
Bladder bloating (if your bladder isn’t emptying completely, it may be tense and swollen)
Swelling of the ankles and legs (known as peripheral edema)
Skin damage in your genital area (sign of urinary incontinence)
Discharge from the urethra (sign of infection)
Abnormalities in the genital area may perform a prostate exam in men or a pelvic exam in women, measure blood pressure, and examine for heart, lung, or neurological conditions.
Nocturia treatment of nocturnal urination
Some recommendations can be made for the treatment of the need to urinate at night, the main treatment is to treat the underlying cause. Apart from this, symptomatic-supportive treatments can be recommended. The causes of nocturia, other treatments used, and some personal preferences are effective in the treatment. Treatment methods include medication and some surgical methods.
Muscarinic receptor antagonists: Muscarinic receptor antagonists (MRAs) are drugs that reduce abnormal bladder contractions. It cannot be postponed – they relieve the urgent need to urinate. They have side effects and are usually moderate. Dry mouth and eyes, acid reflux, and constipation are common side effects. In rare cases, blurred vision, nausea, and difficulty urinating may occur. Side effects of long-term antimuscarinic use in advanced age
These antimuscaric drugs are:
Beta-3 receptor agonist-Mirabegron: This drug relaxes your bladder muscle, helping to increase your bladder’s capacity to hold urine. Therefore, you feel the need to urinate less. In addition, mirabegron also has irritating side effects, but less so than antimucarinics, and can be used in combination with them. Side effects of mirabegron are generally mild, but long-term side effects are unclear.
Diuretic drugs, Loop diuretics: In some patients, with increased blood circulation in the supine position, it is easier for the heart to pump blood to the kidneys and the whole body. Thus, the body produces more urine because the kidneys filter more fluid, which causes waking up to urinate at night. Strong diuretics can be used for this. however, side effects such as dehydration, gout, low serum Na or K levels, low blood pressure and dizziness may occur.
Among the diuretic drugs are:
Desmopressin-ADH: If the reason for urination at night is decreased vasopressin-ADH production, it can be substituted as a drug. If there is excessive urine production at night, this drug may be recommended to reduce urine production. Desmopressin can reduce the number of times you wake up with the need to go to the toilet and allow you to sleep for longer hours without interruption. The tablet is taken before going to sleep in the form of a nasal spray or a disintegrating tablet. It is active for 8 – 12 hours. The drug can be found in different doses, and women need a lower dose than men. As a side effect, Desmopressin can cause a decrease in the level of sodium in the blood. For this reason, blood tests should be done before and during treatment.
Infrequent side effects include headache, diarrhea, nausea, abdominal pain, dizziness, facial flushing or dry mouth. In rare cases, desmopressin causes high blood pressure and swelling of the feet and ankles (peripheral oedema).
Prostate treatment and surgery: Due to the relationship between the prostate and the bladder, some men are prescribed some drugs to relax the muscles in the prostate gland or to reduce its volume.
Closed prostate surgery may be recommended to relieve symptoms of benign prostatic enlargement when bladder functions are affected.
Lifestyle recommendations for nocturia: You can reduce your complaints and improve your quality of life with general lifestyle changes.
1- Maintain good sleep habits: Go to sleep and wake up at the same times seven days a week, and get enough sleep to be active and alert the next day. If you stay in bed longer or less, your sleep quality will deteriorate, avoid napping during the day, sleep in an environment with appropriate temperature, no noise and no disturbing light.
2-In order not to wake up at night with the feeling of urination, drink less fluids in the evening and in the evening. Consume at least 1-1.5 liters of water a day and consult your doctor to drink more water.
3-Reduce alcohol and caffeine consumption as these increase your urine output and can stimulate your bladder. Although they are stated to be decaffeinated, some beverages such as tea and coffee may also contain caffeine, even in small amounts.
4-Avoid heavy meals before going to bed. Certain foods can make your nocturia worse. First, reducing spices and chocolate in the evening may help.
5-Avoid smoking because nicotine is a stimulant and can affect your sleep.
6-When you feel a sudden urge to urinate, encourage yourself to hold your urine longer with the advice of your doctor. This will train your bladder to hold more urine and therefore cause you to urinate less frequently.
7-Reduce swelling in your legs and ankles. During the day, fluid in your body causes swelling down the legs. This condition is called peripheral edema. The fluid returns to the kidneys in a lying position or by elevating your feet for a few hours. This fluid is excreted from the body with urine. If this event occurs at night, nocturia occurs. Lying down in the afternoon or raising your feet up allows you to sleep longer at night without interruption.